Dec. 18, 2013
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by Liz Szabo, USA TODAY

by Liz Szabo, USA TODAY

Fewer older Americans would take blood pressure medications under new guidelines published today in the Journal of the American Medical Association.

High blood pressure, or hypertension, affects 78 million American adults. Only about half have their blood pressure under control.

Current guidelines define high blood pressure as above 140/90 millimeters of mercury. Doctors now advise patients to take medications and make lifestyle changes - such as exercising, losing weight and consuming less salt - with the goal of getting their blood pressure under this level.

While the new guidelines continue to recommend a blood pressure reading of under 140/90 for people ages 30 to 59, they suggest putting people age 60 and over on drugs only if their blood pressure is at least 150/90.

Evidence from randomized controlled trials - considered the gold standard of medical evidence - shows that reducing blood pressure below 150/90 in this age group reduces stroke, heart failure and heart disease, the report says.

But there's no data to show that older people get any benefit from further reducing their blood pressure to 140/90, says lead author Paul James, a professor of family medicine at the University of Iowa.

James predicts patients will welcome the change. Many older patients already take several medications a day, he says.

Some stop taking medications because of side effects, which can range from light-headedness to swollen ankles, elevated blood sugar and low potassium levels, says report co-author Suzanne Oparil, a professor of medicine at the University of Alabama at Birmingham. Oparil said her group doesn't recommend that patients stop taking any drugs they're currently on. Stopping blood pressure drugs suddenly can cause serious side effects.

"While most doctors think it's OK to add another drug, most patients don't really like taking more medicine," James says. "Particularly if you can't prove a significant benefit, most people would opt out."

Some doctors disagree.

Elliott Antman, the president-elect of the American Heart Association, says he's concerned that the new guidelines could leave some Americans with untreated but serious high blood pressure, putting them at greater risk of health problems.

The panel that developed the advice was originally appointed by the National Heart, Lung and Blood Institute in 2008.

Earlier this year, however, the National Heart, Lung and Blood Institute announced that it would no longer put out guidelines for medical practice, leaving the guidelines without a sponsor. Although the panel's work is being published in JAMA, it hasn't been endorsed by specialist groups or the American Heart Association.

That could prevent many doctors from adopting the advice, says Daniel Edmundowicz, chief of cardiology at Temple University Hospital in Philadelphia.

New guidelines are often controversial.

For example, recent advice to expand the number of people eligible for cholesterol medications, announced by the American Heart Association and American College of Cardiology, met with criticism from doctors reluctant to put more people on statins.